Topical Sessions
Please click below for session outlines and confirmed speakers.
Topical Sessions 1 - Monday 14 April 2014, 1.30pm - 3.00pm
Topical Sessions 2 - Monday 14 April 2014, 3.30pm - 5.00pm
Topical Sessions 3 - Wednesday 16 April 2014, 1.30pm - 3.30pm
Topical Sessions 1 - Monday 14 April, 1.30pm - 3.00pm
1A
Core outcome data for children’s acute and chronic pain services
Chair: Professor Kathy Eagar, Australian Health Services Research Institute, NSW
Participants can expect to be updated on the progress of national and international efforts to develop standardised outcome datasets for evaluating and improving pain services to children. Participants will be offered opportunities to engage in lively discussion in session, and join working groups to shape the future direction of national database development and improvement.
Outcome domains and measures for acute and chronic clinical pain services will be discussed. Ethics, logistics, and burden versus benefits for consumers will be considered. In addition to the speakers, many colleagues involved in the development and piloting of the datasets will be present to contribute to discussion. The Chair will facilitate active discussion amongst participants in order to: explore experiences with using outcome datasets/reports; identify benefits and challenges; and establish future directions and methods for advancing consensus and utility.
Presenters:
Professor Kathy Eagar, Australian Health Services Research Institute, NSW
Dr Phil Russell, Princess Margaret Hospital for Children, WA
Dr Susie Lord, John Hunter Children's Hospital, NSW
1B
Pain genetics and epigenetics (and why are they important for both pain clinicians and researchers)
Chair: Associate Professor Kevin Keay, Sydney Medical School, University of Sydney, NSW
This session will begin with an introduction to genes and epigenetics bringing us all up to speed with this growing and influential field of animal and human research and its impact on understanding a host of medical conditions. We will consider animal and human research that reveals key genomic and epigenomic markers for several aspects of the acute and chronic pain experience. You can expect to lose your fear of these terms after listening to our panel of speakers and expand your understanding of their likely importance in the pain biology and pain medicine of the future.
Presenters:
Dr Marnie Blewitt, Walter and Eliza Hall Institute of Medical Research, VIC
Dr Greg Neely, Garvan Institute, NSW
Dr David Mor, Biomedical Sciences, University of Sydney, NSW
Professor Jeffrey Mogil, McGill University, Montreal, Canada
1C
Rheumatology: Sources of pain and individualised care
Chair: Dr Michele Callisaya, Royal Hobart Hospital, TAS
Post total knee replacement pain is a significant issue in roughly a quarter of patients undergoing surgery. As with any persistent pain outcomes there are predictors for pain that predate the surgery, some that relate to the surgery and some from post operative. Attempts to modify the post operative outcomes both intra operatively and post operatively will also be touched upon by Dr Francis.
Pain, exercise and inflammatory arthritis: where to begin? Ms Millner will present on the benefits of adequate levels of exercise for the general population. Appropriate exercise by people with inflammatory arthritis can confer important additional benefits such as decreased pain, increased range of movement, functional maintenance or gain and improvement in mood and sleep. Despite these benefits, adherence to regular exercise programs by people with inflammatory arthritis is poor. This presentation will describe the components of assessment required in order to more accurately develop an individually tailored exercise program including cognitive and physical barriers to exercise. Comparison of objective movement measures with perceived pain, fatigue, function and disease activity measures (including radiographic progression) provides additional information that should feed into the clinical reasoning process, in order to find a safe and achievable starting point.
Professor Jones will present osteoarthritis as the leading musculoskeletal cause of disability in western society. Despite this, it is still difficult to gain a precise definition of what osteoarthritis actually is. It is well known that there is a modest correlation between x-ray changes and pain. However, for knee joint structure there is largely consistent evidence that bone marrow lesions, synovitis/effusions and cartilage defects are associated with knee pain and cartilage loss. In addition, systemic inflammation, muscle strength and obesity predict pain even in the absence of structural knee pathology. Finally, the pain system itself is involved with both pain processing and genetic factors implicated in recent studies. These improvements in basic science have greatly enhanced our understanding that osteoarthritis is an umbrella term for a number of pathways leading to very similar pain and structural outcomes; these outcomes are leading to lesion-specific therapies, which indicate the importance of trying to pinpoint causes of pain in the individual.
Presenters:
Dr Hilton Francis, Royal Hobart Hospital, TAS
Ms Janet Millner, Royal Hobart Hospital, TAS
Professor Graeme Jones, Menzies Research Institute, TAS
1D
The brain in pain: A foray into perceptual dysfunction and its cortical correlates
Chair: Dr Tasha Stanton, The University of South Australia, SA
People with chronic pain often have altered perceptions of their body, as well as altered reactions in response to threat (real or perceived) to their painful body part. This session will present new evidence from both psychophysical and neuroimaging studies to discuss the potential role of the brain in perceptual dysfunction in chronic pain. We will first discuss the presence of perceptual deficits in people with chronic back pain and dysfunctions in their ability to accurately assess information coming from the painful area. We will then discuss the evidence for altered neural processing in the evaluation of threat in people with chronic back pain. Finally, we will discuss alterations to functional representation of the painful body part in a condition often characterised by perceptual distortions - complex regional pain syndrome.
Presenters:
Dr Tasha Stanton, The University of South Australia, SA
Dr Julia Hush, Macquarie University, NSW
Miss Flavia Di Pietro, Neuroscience Research Australia, NSW
1E
Restless legs syndrome (RLS) and its remarkable association with pain
Chair: Associate Professor David Champion, Department of Anaesthesia and Pain Medicine, Sydney Children’s Hospital, NSW
Restless legs syndrome (RLS) has been emerging as a potentially important association of common pain disorders. There have been several independent studies showing strong associations with chronic widespread pain fulfilling criteria for fibromyalgia syndrome. The twin family case-control study conducted by Sydney Children`s Hospital with the Australian Twin Registry has shown associations, some clearly genetic, between RLS and growing pains, migraine, recurrent abdominal pain, and low back pain. Recently Dr Stehlik et al from Sweden have conducted a large population study in adult women and have shown RLS to be associated with acute and chronic pain and that the prevalence of RLS increased with pain severity and duration and especially with greater anatomical distribution. These studies, considered collectively, are indicating a likely fundamental relationship between RLS and pain, especially but not limited to pain disorders without disease. The associations suggest potential genetic links and/or common pathogenesis such as dopaminergic mechanisms which might be amplified by iron or vitamin D deficiency.
Presenters:
Dr Arthur Teng, Department of Sleep Medicine, Sydney Children’s Hospital, NSW
Miss Aneeka Bott, Department of Anaesthesia and Pain Medicine, Sydney Children’s Hospital, NSW
Dr Romana Stehlik, Centre for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Sweden
1F
Providing pain management in a rural setting
Chair: Dr Malcolm Hogg, Royal Melbourne Hospital, VIC
Describing the difficulties and potential benefits of linking tertiary services to community health care in a rural setting.
Dr Malcolm Hogg will present on providing pain medicine to rural clients via fly in/fly out and telehealth strategies.
Ms Janine Enright and Ms Angela O’Brien, Hospital Admission Risk Program (HARP) in Hamilton, VIC, will describe the challenges of providing multidisciplinary care in the country and linking with telehealth in the city.
The learning objectives include how to understand the differences of rural clients, health care in the rural setting, issues regarding teleheath, and developing an appreciation of rural and remote Australia.
Presenters:
Dr Malcolm Hogg, Royal Melbourne Hospital, VIC
Dr Lucy Carter, Swansea General Practice, TAS
Ms Janine Enright, Western District Health Service, VIC
Ms Angela O’Brien, Western District Health Service, VIC
Topical Sessions 2 - Monday 14 April, 3.30pm - 5.00pm
2A
Pain: Familial involvement and impact
Chair: Dr Tiina Jaaniste, Sydney Children’s Hospital, NSW
Although pain is often regarded as an individual experience, it impacts the whole family. An international (Canada and Australia), inter-disciplinary (psychology, nursing) panel will consider: (i) How family members contribute to effective pain management; (ii) How families are impacted when a member has pain.
Dr Chambers will discuss parental involvement in paediatric procedural pain management. She will summarise recent clinical practice guidelines developed to improve pain management and reduce family burden associated with paediatric immunisations. Dr Chambers will exemplify knowledge translation efforts regarding parental involvement in their child's procedural pain management.
Dr Jaaniste will overview the impact of paediatric chronic pain on siblings. She will present new data from an Australia-wide, twin-family project showing that having a sibling with a common pain disorder of childhood renders individuals significantly more likely to experience such a disorder themselves. Dr Jaaniste will also present new data on the functioning of healthy siblings of chronic pain patients.
Dr West will present a project investigating the nature of family resilience and adult chronic pain. An explanatory-sequential-mixed-method design was used, with assessment measures administered to 31 families. Dr West will also present data on the newly (Australian) validated Family Impact of Pain Scale.
Presenters:
Dr Christine Chambers, Dalhousie University and IWK Health Centre, Nova Scotia, Canada
Dr Tiina Jaaniste, Sydney Children’s Hospital, NSW
Dr Caryn West, School of Nursing, Midwifery and Nutrition, James Cook University, QLD
2B
Managing the older person at end of life
Chair: Dr Malcolm Hogg, Royal Melbourne Hospital, VIC
Many older persons suffer debilitating pain at the end of their lives. The clinical conundrum of when and how to introduce concepts of palliation and transfer to a palliative care approach is a difficult one, with few studies to guide decision making process. This session will examine the evidence for advanced care planning, the impact of recommendations for a palliative approach in residential aged care facilities and discuss some symptom management approaches.
Presenters:
Professor Andrew Moore, University of Oxford, United Kingdom
Dr Michael Chapman, Palliative Care Research, Calvary Health Care, ACT
Dr Malcolm Hogg, Royal Melbourne Hospital, VIC
2C
Benchmarking of outcome measures in adults with chronic pain
Chair: Mr Karl Bagraith, Royal Brisbane and Women’s Hospital, QLD
2014 is a year of Australasian collaboration in benchmarking chronic pain outcomes. This follows a long incubation period and early discussions between the Faculty of Pain Medicine and Professor Eagar at University of Wollongong (UoW). In the past two years funding from NSW Health and the Agency for Clinical Innovation has led to the establishment of ePPOC (electronic Persistent Pain Outcomes Collaboration) within the Australian Health Service Research Institute at UoW.
Initial ePPOC implementation has focused on NSW and a business case is under development to allow involvement of other stakeholders across Australia and New Zealand. The Australian Pain Society and NZ Pain Society have been involved in discussions of outcome tools, data protection and clinically utility.
The Victorian Department of Health have also funded a pilot project (vicPPoP) in three pain centres. Initial results will be presented in this workshop. Outcome measurement is also recognised as a strategic priority in QLD as part of the State-wide Persistent Pain project.
In this workshop Professor Eagar will provide an overview of the current status of ePPOC. Developments will be compared with AROC (Australasian Rehabilitation Outcomes Centre) and PCOC (Palliative Care Outcomes Collaboration). Associate Professor Arnold will report on vicPPoP and Dr Hayes will discuss the practical challenges of implementing ePPOC from the perspective of participating sites in NSW.
Presenters:
Associate Professor Carolyn Arnold, Caulfield Pain Management & Research Centre, Alfred Health, VIC
Professor Kathy Eagar, Australian Health Services Research Institute, University of Wollongong, NSW
Dr Chris Hayes, Hunter Integrated Pain Service, NSW
2D
Personalised pain management within a multidisciplinary persistent pain program
Chair: Ms Ann Yeomanson, Eastern Health, VIC
Internationally, clinical evidence and healthcare standards commonly recognise the importance of engaging persistent pain clients in the setting of individualised goals and a connected care-plan for their treatment program.
During this session, experiences of different pain services will be explored in:
1.Connecting Clinician case-formulation and Client problem-identification
2.Developing an integrated Clinician’s multidisciplinary problem lists into a single interdisciplinary (shared) goals and care-plan
3.Reviewing goals and care planning
Efficient systems and documentation templates to address these client needs will be presented. A review of the evidence for personalising CBT based pain therapy will be discussed.
Presenters:
Professor Michael Nicholas, Pain Management Research Institute, University of Sydney, NSW
Ms Sara Brentnall, Austin Health, VIC
Mr Paul Beaton, Eastern Health, Community Rehabilitation Centre, Angliss Hospital, VIC
2E
Empathy and pain: From the neuroscience to the clinic
Chair: Dr Melita Giummarra, Monash University, NSW
When we see others in pain, we resonate with their emotional state, and anticipate the sensory qualities of their pain. This corresponds to activation in affective and sensory brain regions that are involved in personal pain experience. This session gives an overview of the neural underpinnings of empathy for pain, vicarious pain and pain “contagion”, and the role of empathy in the clinician-patient relationship.
Dr Fitzgibbon will discuss the similarities and differences in the neural profile of personal pain experience (including experimental and clinical pain), empathy for pain, and social “pain” (e.g. feelings of rejection through to witnessing another’s embarrassment). She will present evidence for how brain stimulation can be used to measure or manipulate these experiences.
Dr Giummarra will discuss the two key manifestations of pain contagion: acquired pain contagion (e.g. after injury) and the congenital predisposition towards these experiences. Dr Giummarra will present the latest research on pain contagion, and vicarious pain modulation, and discuss how the trait empathy mediates pain contagion only in the congenital group.
Ms Bunzli will discuss the nature and importance of empathy in the clinician-patient encounter, drawing on evidence from the literature, clinician questionnaire data and qualitative interviews with chronic pain patients.
Presenters:
Dr Bernadette Fitzgibbon, Monash Alfred Psychiatry Research Centre, Monash University, VIC
Dr Melita Giummarra, Monash University, NSW
Ms Samantha Bunzli, School of Physiotherapy, Curtin University, WA
2F
Opioids in clinical practice: From pharmacology to policy initiatives
Chair: Dr Tim Semple, Royal Adelaide Hospital, SA
The clinical use of opioids in pain management is being influenced by policy responses to perceived excessive use and misuse in the community. This session will explore selected aspects of interest to the practicing clinician.
The predominant opioid in Australia is Oxycodone, yet aspects of its pharmacology remain in some dispute. Professor Maree Smith will provide an update in regard to its pharmacological properties that have contributed to its popularity.
Dr Adrian Reynolds will present the Tasmanian response to opioid prescribing issues, while Dr Jane Ballantyne will give the North American perspective, including use of the emerging opioid products. A lively discussion will inform and influence your clinical practice.
Presenters:
Professor Maree Smith, Centre for Integrated Preclinical Drug Development, The University of Queensland, QLD
Dr Adrian Reynolds, Alcohol and Drug Services, TAS
Professor Jane Ballantyne, Department of Anaesthesiology and Pain Medicine, University of Washington, USA
Topical Sessions 3 - Wednesday 16 April, 1.30pm - 3.00pm
3A
What can a pharmacist bring to your pain service?
Chair: Dr David Roselt, Aberdovy Clinic, QLD
This session will highlight the various roles that a pharmacist can provide in a pain service including:
• Medication reviews in the community - Many patients manage (or don’t manage) complex medication regimens in the community. Accredited pharmacists are ideally placed to review the whole picture and liaise with prescribers to solve medication related problems.
• Pharmacists in the outpatient setting - Patients treated for both acute and chronic pain may take a suite of medications from a variety of clinicians for a variety of indications. A selection of cases will highlight the pharmacist review process and methods used to rationalise complex medication regimens.
• Pharmacists in research - Pharmacists are continually reviewing the evidence regarding the safe, effective and quality use of medicines. In areas where evidence is lacking or controversial, pharmacists are actively involved in helping to expand the body of information by undertaking research roles. A presentation on the use of ketamine will be used to emphasise this role whilst delivering a unique piece of research.
• Formulating medications to treat complex pain - Pharmacists in the acute hospital setting also assist with “therapeutic logistics”. They identify and source alternative products for patients unable to take conventional preparations and ensure that ongoing access is practical for the patient. The final presentation will focus on compounding unusual formulations and the role the pharmacist has in optimising patient-centred care.
Presenters:
Dr Peter Tenni, University of Tasmania, TAS
Arti Thakerar, Peter MacCallum Cancer Centre, VIC
Olly Zekry, University of Sydney / Royal Prince Alfred Hospital, NSW
Jade Eyles, Austin Health, VIC
3B
Analgesic efficacy and mode of action of small molecule angiotensin II type 2 receptor (AT2R) antagonists for neuropathic and inflammatory pain
Chair: Professor Maree Smith, Centre for Integrated Preclinical Drug Development, The University of Queensland, QLD
Neuropathic pain and pain due to cancer bone metastases are major unmet clinical needs. Our work shows that selective small molecule angiotensin II (Ang II) type 2 receptor (AT2R) antagonists produce dose-dependent analgesia in rodent models of neuropathic pain and cancer-induced bone pain. In nerve-injured mice null for the AT2R, analgesia produced by the AT2R antagonist, EMA300 was abolished, affirming the AT2R as the receptor target.
The analgesic mechanism in these rodent models involves blockade of augmented angiotensin II/AT2R signalling in the lumbar DRGs, to attenuate NGF/TrkA signalling and inhibit p38 mitogen activated protein kinase (MAPK) and p44/p42 MAPK activation. In human peripheral nerves, the major AT2R ligand was Ang II. By ELISA its levels were similar in control human nerves, injured nerve trunks, and painful neuromas. By contrast, Ang III and Ang-(1–7) levels were undetectable.
In cultured human DRG neurons, Ang II increased p38 MAPK and p44/p42 MAPK signal intensity that was partially reversed by EMA401, an orally active AT2R antagonist. The clinical efficacy of EMA401 was reported recently in post-herpetic neuralgia; our studies indicate potential efficacy of AT2R antagonists in multiple clinical neuropathic and inflammatory pain states.
Presenters:
Professor Maree Smith, Centre for Integrated Preclinical Drug Development, The University of Queensland, QLD
Dr Arjun Muralidharan, Centre for Integrated Preclinical Drug Development, The University of Queensland, QLD
Professor Praveen Anand, Department of Clinical Neuroscience, Imperial College London, United Kingdom
3C
Endogenous modulation of nociception and pain
Chair: Dr Michael Farrell, Florey Institute of Neuroscience and Mental Health, VIC
The neural hardware of pain is a two way street. Pathways from the periphery to the brain propagate ascending afferent traffic, while alternative pathways from the brain to the spinal cord provide a descending route for inputs that can modify the incoming nociceptive signal. This session will focus on the descending pathway and how its function can impact of the experience of pain.
Professor Mac Christie will discuss endogenous modulation of nociception from the perspective of basic science, with an emphasis on the pharmacological processes involved in descending control of pain. A presentation by Dr Leonie Cole will address regional responses in the human brain that have been implicated in top-down modification of pain responses. Finally, Dr Ann Meulders will place inhibition in the context of fear avoidance. Her presentation will extend our understanding of endogenous inhibitory control to the modulation of fear and avoidance triggered by pain. She will discuss research that shows that generalised fear responses modulate inhibitory control and inhibitory mechanisms can modulate fear and avoidance.
Presenters:
Professor MacDonald Christie, School of Medical Sciences, The University of Sydney, NSW
Dr Leonie Cole, Florey Institute of Neuroscience and Mental Health, VIC
Dr Ann Meulders, KU Leuven University, Belgium
3D
Innovative delivery of paediatric chronic pain management programs
Chair: Dr Meg Goodison-Farnsworth, Sydney Children's Hospital, NSW
Interdisciplinary team management approaches differ around the world and there is no clearly defined standard. This workshop will showcase some innovative approaches to managing paediatric pain across Australia.
Dr Kathleen Cooke will outline the Linking Emerging Adolescents in Pain (LEAP) and Support Kids in Pain (SKIP) programs in Brisbane. The benefits and short comings of different models of care provided for groups, individuals and also online will be discussed. Lessons learned, early outcome data and future vision will be presented.
Natasha Haynes will present the Children’s Hospital Westmead (CHW) experience of developing and piloting a Paediatric 5-Day Program for adolescents with chronic pain. Literature and research data that formed the foundation for the structure and content of their program will be presented along with preliminary results.
Marianne McCormick will discuss demographics and clinical characteristics of patients and their parents who present to a tertiary chronic pain clinic. She will share experiences and 2 years of data related to the development and implementation of an Innovative Day Program for Paediatric Chronic Pain. The Acceptance and Commitment Therapy based program is aimed at maximising function and facilitating full school attendance. Importantly, the vital integration of hospital school into the rehabilitative process will be discussed. The designing and implementation of a Parent Education and Management program will be discussed, highlighting the need for this component to be included in the management of paediatric chronic pain.
Upon completion of this session attendees will have a better understanding of effective pain team and program structures and practical tips on developing innovative pain management programs for children and adolescents with chronic pain.
Presenters:
Dr Kathleen Cooke, St Vincent’s Hospital, QLD
Ms Natasha Haynes, Children’s Hospital Westmead, NSW
Ms Marianne McCormick, Chronic Pain Team, Sydney Children’s Hospital Randwick, NSW
3E
Orofacial pain
Chair: Associate Professor Kevin Keay, University of Sydney, NSW
2013-2014 is designated the Global Year Against Orofacial Pain. This symposium will highlight Australian contributions to understanding and treating this frequently encountered form of pain. Participants can expect to be informed of recent neurobiological, human experimental and clinical investigations into pain perceived in the face and/or oral cavity.
Presenters:
Dr Ernie Jennings, James Cook University, QLD
Associate Professor Luke Henderson, Sydney Medical School, The University of Sydney, NSW
Professor Christopher Peck, Sydney Dental School, NSW
3F
The many faces of the neuroimmunology of pain
Chair: Dr Mark Hutchinson, University of Adelaide, SA
Neuroimmune contributions to pain can take many forms. Here we will highlight immunogenetic predispositions, cognitive stress alternations of glial function, and drug induced adaptations in central immune processing.
Presenters:
Dr Janet Coller, University of Adelaide, SA
Dr Rohan Walker, University of Newcastle, NSW
Dr Mark Hutchinson, University of Adelaide, SA